Expectation of Unpleasant Events in Anxiety Disorders

  • STATUS
    Recruiting
  • End date
    Sep 24, 2029
  • participants needed
    1241
  • sponsor
    National Institute of Mental Health (NIMH)
Updated on 15 September 2021
anxiety
panic disorder
specific phobia
mood disorder

Summary

Fear and anxiety are normal responses to a threat. However, anxiety is considered abnormal when the response to the threat is excessive or inappropriate. This study will examine changes in the body and brain that occur during unpleasant learning experiences in healthy volunteers with high, moderate, and low levels of anxiety.

A high degree of generalized anxiety is a component of many anxiety disorders and is regarded as a marker of vulnerability for these disorders. People with anxiety disorders and individuals with high degrees of anxiety have inappropriate expectations of unpleasant events. This study will investigate the development of expecting unpleasant events in healthy volunteers with varying degrees of anxiety using aversive conditioning models. A later phase of the study will enroll participants with anxiety disorders and compare their responses to those of healthy volunteers.

Patients who meet criteria for an anxiety disorder, and healthy volunteers who have no history of psychiatric or major medical illness will be enrolled in this study. Volunteers will come to the NIH Clinical Center three times for outpatient testing....

Description

High-generalized anxiety is a concomitant of many anxiety disorders and is often regarded as a vulnerability marker for these disorders. One characteristic of patients with anxiety disorders and high trait-anxious individuals is inappropriate expectancies of aversive events. The overall aim of the present protocol is to investigate mechanisms that may promote the development of these aversive expectancies using expectancy-based, associative-learning models.

During aversive conditioning in which a phasic explicit-cue (e.g., a light) is repeatedly associated with an aversive unconditioned-stimulus (e.g., a shock), the organism develops fear to the explicit cue as well as to the environmental context in which the experiment took place. We have obtained preliminary evidence suggesting that contextual fear represents aspects of aversive states that are central to anxiety disorders. In this protocol, we seek further evidence for the relevance of contextual fear to mood anxiety disorders.

One important determinant of contextual fear in both humans and animals is predictability: contextual fear increases when aversive events (e.g., electric shock) are unpredictable, as opposed to when they are predictable. The present protocol will examine the role of predictability of aversive states and of conditioning on threat appraisal in individuals with mood and anxiety disorders.

A second aim is to examine the interaction between experimentally-induced anxiety and cognitive processes, more specifically working memory, in mood and anxiety disorders.

Details
Condition ANXIETY NEUROSIS, Anxiety Disorders (Pediatric), Generalized Anxiety Disorder (GAD), Generalized Anxiety Disorder (GAD - Pediatric), Anxiety Disorders, anxiety disorder
Treatment Acoustic startle, Electric Shock
Clinical Study IdentifierNCT00055224
SponsorNational Institute of Mental Health (NIMH)
Last Modified on15 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Inclusion criteria for both patients and healthy controls
All subjects must be able to give written informed consent prior to participation in this study
PATIENTS ONLY: May have DSM-IV-TR diagnoses of an anxiety disorder (GAD; SAD; Panic disorder; specific phobia) or mood disorder (MDD; BP)
PATIENTS ONLY: May be taking the mood stabilizers, Depakote or Lithium Carbonate
Speaks English fluently

Exclusion Criteria

Exclusion criteria for healthy subjects
Female subjects who are currently pregnant
Subjects who meet DSM-IV criteria for current alcohol or substance abuse
Subjects with a history of alcohol or substance dependence within 6 months prior to screening
Current Axis I psychiatric disorders as identified with the Structured Clinical Interview for DSM-IV-TR axis disorders, non-patient edition (SCID-np). Past history of any psychotic disorder or bipolar disorder
I-Q<80
Medical illnesses (such as diabetes or hypertension) or neurological illnesses (such as carpal tunnel syndrome for shocks to be delivered on affected arm; organic brain impairment; seizure disorder) likely to interfere with the study
Subjects who are on a medication that may interfere with the study
Employee of NIMH or an immediate family member who is a NIMH employee
Exclusion criteria for patients
Patients who would be unable to comply with study procedures or assessments
Female patients who are currently pregnant
Patients who meet DSM-IV criteria for current alcohol or substance abuse
Subjects with a history of alcohol or substance dependence within 6 months prior to screening
Patients who are on a medication (other than mood stabilizers lithium carbonate or Depakote) that may interfere with the study
Medical illnesses (such as diabetes or hypertension) or neurological illnesses (such as carpal tunnel syndrome; organic brain impairment; seizure disorder) likely to interfere with the study
Patients will be excluded if they have a current or past history of, delirium, dementia, amnestic disorder, any of the pervasive developmental disorders; or cognitive impairment
Current Axis I psychiatric disorders as identified with the Structured Clinical Interview for DSM-IV-TR axis disorders, non-patient edition (SCID) with the exception of the mood and anxiety disorders. Past history of any psychotic disorder or bipolar disorder
IQ<80
Employee of NIMH or an immediate family member who is an NIMH employee
Additional exclusion criteria for the active avoidance task
Color blindness
Clear my responses

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